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HomeMy WebLinkAbout0077 COACH LANE - Health 77 Coach Lane Barnstable A=298 075 i C7 i i 1 I t I � i Ji i I I 1 I 1 1 i 1 • 1 TOWN OF BARNSTABLE LOCATION -7'7 aAj�' 1_q SEWAGE# ,.01'7- .I_: .3 VILLAGEo'A- �a- ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. t<. 1. 570 1�' `17I SEPTIC TANK CAPACITY 15b0-&A2_ r LEACHING FACILITY.(type) L— y��C,��{ (size) NO.OF BEDROOMS -,;5— OWNER C U= 1 Gl_ PERMIT DATE: 7--p 51- 177 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 4-- Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY i 3 =on , 4o a�ro ��� i No. PO l 7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS ftpYitation for Misposar 6pstrm Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade(,Abandon( ) Complete System ❑Individual Components Location Address or Lot No.,r)1) C-n Owner's Name,Address,and Tel.No.SU&-DWG 3369 2k cfp . Sc�(nnw`7 Assessor's Map/Parcel oZ gfS �� �� /L11S0 , C?ve�e�- oats Installer's Name,Address,and Tel.No. ')�/—��/� Designer's lqame,Address,and Tel.No. RVrl OLD=C'vr-6d'�'em,741y_. Po•mac '70(/ awn Q u,,,� rre :��g.✓ /i,1S �'Itc/bb ns M; S O Type of Building: �a ' o V Dwelling No.of Bedrooms P�X�S� P� Lot Size 3J 99 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) °J�—'C� gpd Design flow provided gpd Plan Date' Aw-��,�O� Number of sheets I Revision Date / Title i e- `� P Size of Septic Tank J 5 p© a/D Type of S.A.S.'y ej4-jb) sz 31,4 1e?. ' Description of Soil -5,¢, SC1 # G� Nature of pairs Alt r ns saver whe app�1' able) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 lofhe Environmental C nd of to place the system in operation until a Certificate of Compliance has been issued by this Boar Health. Si Date �7 Application Approved by Date �� Application Disapproved by Date for the following reasons Permit NO. � t Date Issued —f ..- No. ;�o ' _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWWOF BARNSTABLE, MASSACHUSETTS ltlYicati0n for, isposal stem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(,1),Abandon( ) RrComplete System ❑Individual Components Location Address or Lot No.r)n Cca_&� 6\,., • Qwner's Name,Address,and Tel.No. .5U£5 3 3o9 Assessors Map/Parcel R �, r�5- C-M't�C1 Installer's Name,Address,and Tel.No. Designer's 14ame,Address,and Tel.No. _,0g- 34--k ysy/ R�rF t��� �'v1�s�'1u,�!-;c,,,,;�-�x • ?o•l3ax }c,�Y�C? 1 rc S3�r5�rGsrS¢ Type of Building: /} DwellingNo.of Bedrooms eX�5�t'' Lot Size '7 s .ft. Garbage Grinder 5 � 7 q g ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Dat,. a� a0l� Number of sheets Revision Date Title �/Y f'P SI t�'�ClM �C 7 7 ( iti �°�nit f"/i44dA 6e 'A `A Size of Septic Tank / Type of S.A.S.?,! 114 1 b) �ic�c�(�%��.�p�in� Y12 K /07.83 r Description of Soil, 4_e.e._ , 7 J - r Nature of epairs or Alte a ions swei wh app' able) TL _ ( r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in - `accordLce with the provisions of Title 5 of the Environmental Code-and'not to place the system in operation until a Certificate of Compt ance has been issued by this Board of Health. ~ Si_ ,�� ��- � Date 7 j Application Approved by Date /CJ-f Application Disapproved by Date for the following reasons Permit No. .20 ( Date Issued -7 fq —t ------------------------------- -------------- -- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance a THIS IS TO CERTIFY,that the Op-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by r,'l)l�(d/' 11140'f U"t, I at / / (IA4, Al n� .1'!� has been constructed in accordance q �j with the provisions of Title 5 and the for Disposal System Construction_Permit No' �l�dated r f 7` Installer l uzQ'c)l(� C r{��i ��y+, Designer �a r�„Cc,f 2 e dcA—L." -1 r)<- #bedrooms Approved design flow ' &K) gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ---------------------------------------------------=----------------------------=------------------------------------------------ ------ No. gO (l7 /� Fee �V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 33isposal *pstem Construction Permit Permission is hereby granted to 0b... ruct( ) Repair( ) Upgradep,) AbandonSystemlocated at � 0 /(��stl ���b�y iz and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. �^ + Date `� Approved by � t '^i 9, i A ' �r� t � 1 7-Oq(o Town ®f Barnstable ALd Regulatory Services o� Thomas F. Geiler,Director eg Public Health Division � t639. 0 jDPFarnn't"� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-464.4 Fax: 508-790-6304 Installer&Designer Certification Form Date: 29 Sewage Permit# Assessor's MaptParcel 2 8 5 Designer: �/�E lmMNfa__ Installer: pffgpL0777 cm4r UCfiDN Address: q3q MAIN 5T Address: 45 1NI�V5M PD 07- 75 On was issued a permit to install a �'�G�'11 �C� (date) (installer) septic system at 77 CW 9 LANE, Br42.r\19ME�—1 based on a design drawn by (address) Q it�L A 9_3ALA, ft. dated 612-9117 (designer - I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. l �� DANIELA. tiN (Installers Signature) G OJALA CIVIL N No.46502 /STER SS NG (Designer's Signature (Affix Des'grier�',:94S1amp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc vK� � 4-6 lA,r rT �. As a J . z ��c�h ca�►e � �am�:"��. �wra � � aumrvoc� f Y COMMONWEALTH OF MASSACHUSETT S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION s TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY' ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION rl� 0 t;0j, Property Address: 27 fCU-qtGA 1-4If ✓2���— .a r t Owner's Name: Owner's Address: 77 a c�► t...ctne Date of Inspection: Name of Inspector: (please print) Company Name: araQ,vnrfc �Ayi/brirt ,r ) InSpee+100s `30 Mailing Address: r� Telephone Number: SOS '385- 760$ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection..The inspection was performed based on'my training and experience in the proper function and maintenance-of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _Pe Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signattare: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10;000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address flow the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 pa-e 1 Page 2 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL`SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 7 7 COaG4 I-ok^e Owner: RaP� Date of Inspection: 6 / t!yeg Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have-not found any information which indicates that any of the failure criteria described in 310 CNM . 15.363 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"sec " n need to be replaced or repaired.The system,upon completion of the replacement or repair;as approv y the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the fol ing statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or a septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration r tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic as approved by the Board of Health. *A metal septic tank will pass inspection if it is s cturally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years of is available. ND explain: Observation of sewage bac p or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a br en,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The s tem required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspec 'on if(with approval of the Board of Health);- broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 1 1 OFFICIAL INSPEC a ION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continded) Property Address: 7 2 r,,,k Owner: e Date of Inspection: Es 06 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in rder to determine if the system is failing to protect public health, safety or the environment. I. System will pass unless Board of Health determines in accord ce with 310 CMR 15.303(I)(b)that the system is not functioning in a manner which will protect pu is health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering v getated wetland or a salt marsh 2. System will fail unless the Board of He th (and Public lWater.Supplier,if any) determines that the system is functioning in a manner that pr tects the public health,safety and environment: ' _ The system has a septic tank soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary a surface water supply. _ The system has a septic and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a se p c tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has eptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply ell**.Method used to determine distance- "This system p sses if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and v atile organic compounds indicates that the well is free from pollution from that facility and the presence f ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure crit is are triggered. A copy of the analysis must be attached to this form. 3. O er: 3 Page 4 of 11 OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE D1SiPOSAL:SYSTEM INSPECTION FORM t. PART:A CERTIFICATION(continued) ' Property Address: 77 Co2c.4 kh,c Owner: ane ' Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No k' Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool or Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool e Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow or Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped or Any portion of the SAS, cesspool or privy is below high ground water elevation. te Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. a_..G Any portion of a cesspool or privy is within a Zone I of a public well. w Any portion of a cesspool or privy is within 50 feet of a private water supply well. a Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.[This system passes if the well water..analysis, performed at a DEP certified laboratory;for coliform bacteria and volatile organic-compo=ds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal,to or less than S.ppm,provided that no other failure criteria ]� are triggered.A copy of the analysis must be attached to this form.] /w (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a des' ow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems:in.addition to th teria above) yes no _ the system is within 400 feet of a surfa drinking water supply — the system is within 200 feet o tributary to a surface drinking water supply . — _ the system is located ' nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public ter supply well f If you have answered" s"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D ' ove the large system has failed.The owner or operator of any large system considered a. significant threat der Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The sy, ern owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 77 6mr-4 Owner: Q k Date of Inspection: Check if the following have been done.You must indicate`yes"or"no"as to each of the following Yes - No _ Pumping information was provided by the owner,occupant,or Board of Health p' Were any of the system components pumped out in the previous two weeks? < _ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? o(_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) { — Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out? Were all system components,excluding the SAS, located on site? Were the septic tank manholes uncovered,opened,.and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of scum? _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR ?5.302(3)(b)] 5 i r Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEM INFORMATION Property Address: 77COC.Ck L-._,� Owner: /7'-QZ[yjfq Rate of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms):330 Number of current residents: . a Does residence have a garbage grinder(yes or no):N0' Is laundry on a separate sewage system(yes or no):M [if yes separate inspection required] Laundry system inspected(yes or no): 00 Seasonal use: (yes or no): P-JO , Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no):tJO Last date of occupancy: GVr11r4 COMM ERCIALIINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): _ gpd Basis of design flow(seats/persons/sqft, Grease trap present(yes or no): Industrial waste holding tank pr nt(yes or no):— Non-sanitary waste discharo to the Title 5 system(yes or no):_ Water meter readings,if ailable: Last date of occupan /use: OTHER(des i e): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):AD If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM A4eptic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: T Were sewage odors detected when arriving at the site(yes or no):�d 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: s—f Owner: Date of Inspection: BUILDING SEWER(Iocate on site plan)44 Depth below grade: Iro Materials of construction: cast iron ( 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage, etc.): SEPTIC TANK: (locate on site plan) Depth below grade: SD" Material axplain — of construction _other(e : concrete meta( fiberglass__polyethylene ass_ .If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no —(attach a copy of certificate) Dimensions: `000 rev/ Sludge depth: .7 s Distance from top of sludge to bottom of outlet tee or baffle: K Scum thickness: 07~ ' Distance from top of scum to top of outlet tee or baffle: /d tr Distance from bottom of scum to bottom of outlet tee or baffle: /3 w How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlyet invert,evidence of leakage etc. : n c `{ 4 rS �a 6d C� J 1�nJ oVe �.�C A ce►e tt ont, GREASE TRAP:_(locate on site plan) Depth below grade: . Material of construction:_concrete metal fiberglass yethylene other (explain): — — — Dimensions` Scum thickness: Distance from top of scum to top of outlet tee or affle Distance from bottom of scum to bottom of tlet tee or baffle: Date of last pumping: Comments(on pumping recommend ions, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidenc of leakage, etc.): 7 Page 8of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) .. , Property Address: 77 Co" 1.p,..t r Ins Owner Date of Inspection: TIGHT or HOLDING TANK: (tank must be pumped at a of inspection)(locate bn site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: 7* working Design Flow: ay Alarm present(yes or Alarm level: der(yes or no): Date of last pumping: Comments(conditionitches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): 11 b orx i.��ac IP�G/�6��y 4:�_ry Ao .5(16 ® �Carn�o • PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no):. Alarms in working order(yes.or no Comments(note condition of p p chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 1 I OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 7 CoG, . L�ct, . 0.r Owner: tc.w l Date of Inspection: L (°l O6 SOIL ABSORPTION SYSTEM (SAS):_j[(locate on site plan,excavation not required) If SAS not located explain why: Type _ j( leaching pits,number: / leaching chambers,number: leaching galleries,number: leaching trenches, number, length: leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Aas t C x � cs f ro v,&J4 a t r.a f a h CESSPOOLS: (cesspool must be pumped as part of tion)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: ~ Depth of solids laver: Depth of scum layer: „ Dimensions of cesspool: Materials of construction: Indication of groundwater i ow(yes or no): Comments(note conditi of soil, signs of hydraulic failure, level of ponding,condition of vegetation;etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note co ition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): I 4 9 t Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: —747 6c(, rr Owner: Date of Inspection: 6 p SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. Page l I of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7- CaaII /f(A Owner: `Tar Y.d- u Owner: GekG Date of Inspection: SITE EXAM Slope 00. Surface watery Check cellar Y� Shallow wells IVo Estimated depth to ground water aS feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation). X Accessed USGS database-explain: You must describe how you established the high ground water elevation: U464S Mctps s6w aa. a 6ua+,o,4 p oven _26—.9rre�, lI . 0 �,. TOWN OF BARNSTABLE LOCATION7�()/•�G SEWAGE VILLAGE l�R�i�S �ti. ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. D )G(1z e /c 3 _.4 1 8 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER ,lwe`C BUILDER OR OWNER 6tll DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 13 VARIANCE GRANTED: Yes No r �� 1� .b �� --. ��,r: � Town of Barnstable P It 1-6 3 `J Department of Health,Safety,and Environmental Services Public Health Division Date �/� 367 Main Street,Hyannis MA 02601 M HARMADIA MARS. 1639. Date Scheduled 119h -7 Time Fee Pd. Soil Suitability Assessment for Sew-age Disposal 0' 10k Witnessed By: VQ7Y_,�� Performed By: .0 Location Address Owner's Name C"fl —Address- Assessor's Map/Parcel: e2 9J Engineer's Name LA)A NEW CONSTRUCTION REPAIR Telephone# c pS) Land Use ram' Slopes Surface Stonescw,6f�,o_?3w_,1e A V Distances from: Open Water Body 4 NCO ft Possible Wet Are, I ft Drin I king Water Well I v. Drainage Way IC peg f 44 ft Property Line _ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic) Depth to Bedrock Depth to Groundwater: StandingKaterin.ljole:, ,Weeping fr om Pit Face- Estimated Seasonal High Groundwater . ......................... ..... L Me d,io...d L­fs­e­�': ..........N.................. ... ..... ..XR aiii. .............. ..... .. .A. . . .......... ... ........................... ... ...7 Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment R. Index Well# -Reading Date: Index Well level.__ Ad.l.factor Adj.Groundwater Level Tea ............... . x ...11 ......I ............I Observation Hole# Time at 9" Depth of Perc 5q' Time at 6" Slad Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./inch 4?, Mkt Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health'Division Observation Hole Data To Be Completed on Back Copy: Applicant ......................... � � � ` ` . � � � . ` � � � � � � � � � � � � � � � � Depth from Soil Horizon Soil Textur Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. 6— !&A Depth from Sol!Horizon Soil Texture' Soil Color soil Other Surfac4 (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel) Depth rrom Soil Horizon I Texture Soil Color soil Surface(in.) (U (K-lunsell) Mottling (Structure,Stones,Bouldercs. Depth from) Soil Horizon oil re Color Soil Other Surface(in. (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Con sistency.%Gravel) � Flood Insurance Rate Map: Above 50N year Ovodboundary nw rmX__ ~ Within 50N year boundary No mes___ Withiu100 year flood boundary NvX� Yes___ Depth of Naturally Occurring Pervious Material Does ot least four exist in all areas observed throughout tile area proposed for the soil absorption system? l[not,what io the depth n[naturally occurring pervious material? __________ _ ' -- Certification loed\fvtbut l have passed the soil evaluator examination approved hythe Department ofBnvilonGbcntol Protection and that the above analysis was performed hymu consistent with the required training,expertise and experience described in 3 10 CMR 15.017. Signature Date h �� -- No.........- .. . Fes$..e� p-7 y ;V THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH AMOVED TOWN OF BARNSTABLE &!Ts"b ry orgn®rat Appliration for Diipntial Works Tomi Jatt iq Date Application is hereby made for a Permit to Construct or Repair ( } an Individual Sewage Disposal System at: ..........:.....� ... ..... ....._ Ca �yocation ddress . --- ----•..................................... .w . ... ems....C�i. ZG�� �...CC Vl .... .._ or o. .. .. .... Ow, er //�� A�dd�re�ss i a _______ ___ ____•-_-__•_•_•_-._.. ..._`_ -------------------------------------- ...----•-------• WI-✓v a.�P ( 4/C ---. ...... ...._..__. Install Address�r����,�44..��** UType of Building Size Lot._V.T,_j_ .....Sq. feet Dwelling—No. of Bedrooms________ __________________________________Expansion Attic ( ) Garbage Grinder ( ) Other 0.ai —Type of Building ---------------•------------ No. of persons____________________________ Showers (- -->--- Cafeteria ( ) Otherfixtures ----------------------------------------------------------------------------------------------------------- ......---- W Design Flow..........55...........................gallons per person per day. Total daily flow--------3:a®.......................gallons. WSeptic Tank—Liquid capacity_�SX?__.gallons Length__ ._6.... Width.__A.0.... Diameter________________ Depth__4__4?___.. x Disposal Trench—No_____________________ Width....(--------------- Total Length.......... Total leaching area____..___.__._......sq. ftt Seepage Pit No._______t----------- Diameter......I ?________ Depth below inlet.... Total leaching area_�q��� �� Z Other Distribution box ( 1d Dosing a ( ) ~' Percolation Test Results Performed by---- ....... -------------------- Date----t................................. a Test Pit No. 1_��___.minutesperinch Depth of Test Pit----����i_e�__ Depth to ground water_____-_�_` (� Test Pit No. 2._!�Z__._minutes per inch Depth of.Test Pit__.:f_5_�'____. Depth to ground water.......t1e_m-,�.... ODescription of Soil _ ---- .....................------------------------------•-------•------------.----.....----•--- V .----------------------------------------------------•--------------•----------------------------F'------...----------------•----------------------------•--------------------------•-••-------•.._...--- W U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------------------------------------------------------------------•--•--------...-----•----------------------------------------------------------------------------•-••---•----------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli s en ' ued by the board of health............ Signed --------- -------- -----------............... ----- ...... —-- Application Approved By ......... - - -- --- ------ - - ` ............................ ------- V:-��.--.`-- Dae Application Disapproved for the following reasons: ................................................. --............................................................................. - - -- --------------------- --- ------ - ----- ------------ -------------- Permit No. ----- ............ Issued .......... G.. ' -.�z Dace : Ilk p .7 y ;C) THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Binpuiia1 Workii Towitrurtiu� anti# Application is hereby made for a Permit to Construct (V) or Repair( ) an Individual Sewage Disposal System at: Location-Address uZZ G W�QJJ... .....�.I z G;�24 h 7Heo v)e or Lot No..:............................................................... ..... .............•........... .. a •- -.....---••-----•�•�S` =_.Y5c•---•.........::..............•-----•- ............ VVV Installel/ Type of Building Size Lot....1 feet Dwelling—No. of Bedrooms--_-----3----:i�.........................Expansion Attic ( ) Garbage Grinder ( ) aI, Other—Type of Building ............................ No. of persons.......................... Showers ( ) — Cafeteria ( ) d Other fixtures ......................................................... - W Design Flow..........55..........................gallons per person per day. Total daily flow.._.....33 ........�_..........__galloPs. WSeptic Tank—Liquid capacity.f�D_.gallons Length...._(.--- Width...4.k:-__*Diameter................ Depth... .9.... x Disposal Trench—No. .................... Width....I,.............. Total Length.................... Total leaching area...._.---.._-------sq. fft/t Seepage Pit No._______t........... Diameter......1.9.__..... Depth below inlet.... _____.. Total leaching area.5 ...X1Sq-ft`1r"�� Z Other Distribution box (A Dosing an ( ) Percolation Test Results Performed by--••02,� ... 5a�1------------------ Date---�� �'=� --------- W , Test Pit No. l.L_ _...minutes per inch Depth of Test Pit----15��._ ._ Depth to ground water..___...5_. ..... f14 Test Pit No. 2._G ------minutes per inch Depth of Test Pit-----L. L----- Depth to ground water------- ----------�----•^----p---�----------- --------------------------------------------------- O Description of Soil..................... �3 `"' ....... V .........--•••--•••••-•-•-•---•---•--•--•---••----•---•---•-----•---------•-•-•......•--•••------•-•-•----••------•-•-•••-•-••---••--......--••----•-•-••-•----•-•.................•---...•-•.........-- W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------------------•-------------------------------------------------•------....•----••-•----•-••--------•---•-•----•---•--•---•-•.................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia cep_ as den i ued by the board of health. Signed ----- ----- ----- �/_� 0---------- Date O. Application Approved Byy� � t - - - - ,1 Application Disapproved for the following reasons: ----....... ....---- ..... .. .......... .. ......... .............. Permit No. . .... .... ' ------------- Issued ---------- 2- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CITex#iftrafiE of Tomplinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by '•'.^I scalier ------------------------------------------------------------------------------------- at ---------- -�..-CAP 1 G• '1 !.... -- ---------------- - - has been installed in accordance with the provisions of TITLE 5 of The StUg Environmental Code as described in the application for Disposal Works Construction Permit No. ... ...� r .. dated ._Z........1-14.:. %: THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................ ........ -------.: ............------........................ Inspector ---------------............... _,. ) , ..............------- - --------------- .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.9.X....� Difivusn1� urk Cunntriiurt Vantit Permission is hereby ranted-------••• - .....------..1 . .. `? 9'7�!! Y g ....--••-........_.. to Construct ( �or�,rair ( ) an Individual Sewage�,Das sal System _ Street / as shown on the application for Disposal Works Construction Permit t. ated.... -' ........................... ..:: ............................................................. / . , v Board of Health DATE....................................._�? FORM 36508 HOBBS&WARREN.INC..PUBLISHERS CoO,CO �aTc+} ti�,AZA ZAaATF- I s4 50 � LA PI I \ A (J V 6" �t J p1c >i; L 68 9 TA 4-11 i5ro `5 8 7.7 so N e�C�'�Jo �I.L MNJ�1o� 5cq�.E� I � •iEST �40L-s - 04 -r oF - - - - - --- ---- - �4.40 .23 - --- -- - - -- � ZI►�+���� ��� 1,�a c�►uJ �. / z� P645Fgo�ac- arm 5 ' & � ;154.sc, IL 7-4- I'��f LA\r::;� Fc Z' t z CiIZ.�IEL l-2A�/El- ' plEa� 724 . OF �9`�a�, 45,G lS� 42.5 15� EVERETT H. t �`r EVERETT H,INCKL f9G �4 �pT �IJGO►�f ,�G7 j HINCKLEY "I " F{3230EY v p� 1787 CIVIL i 5 'PAIL"( Lbt�: (3�t�p�5, x Ilo4rC>r- 5r SSfTv- 'W)1- � FA ►UT�- s IT se- �E v,). snR.4,2TbE!,�r4A, pQ�.�o {�2 I. Coti}(T�AG('b2• `ro. � ��o,JS�eIE �oR-'r��. AU- LrTlL1-T-iEZ,,VAZo%. A-Y'::' LJKh--E0 !�1Zot�►J�� '�jZ.�OrL-'�O .d►•1J`l ��0� O�- IL �sas� z-s 5>► ,X' ALL SYTE SHALL SYSTEM PROFILE ILE MAR ED WITHCMAGNETICTTAPE OR BE LEGEND (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 99 EXISTING CONTOUR ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE NOTES _ — TOP FOUND. EL. 92.3 , FILTER FABRIC OVER STONE 1. DATUM IS NAVD 88 99, X EXIST. SPOT ELEV. \ 91 •0 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 90.0-91.8' —[99]— PROPOSED CONTOUR NOTE: 2" MIN. WALL 2. MUNICIPAL WATER IS EXISTING \o c oute 6 PRECAST H-10 BLOCKS OR RISERS (TYP.) THICKNESS REQUIRED PRECAST RISERS 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. o o a> [98.4 PROPOSED SPOT EL. 20 4"OSCH40 PVC MORTAR ALL > o 6" MIN. SUMP PIPES LEVEL 1ST 2' COMPONENTS H-10 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS TH 1 12" MIN. INT. DIM. 4' (�yP) INV'S EL. 88.0 4' TO BE AASHO H— TEST HOLE ENDS o;0;0;0 1500 GAL H-10 DES 88.f33 O ..... , . P'^iP'O�P'OeeP'^cVOP° � . p ae. 10" moos �mao o°000 o 000 ° ° ° ° ° e *89.2' 14' °°°°°O °o°o°o° 5. PIPE JOINTS TO BE MADE WATERTIGHT. TEE SEPTIC TANK TEE o ° 2% SLOPE OF GROUND 88.81 88.56 °o°o°o . �'• °o°o°o°o°o°o WATERTEST D BOX O >°o°0000° °o°o°o°o �USh° 9 o ° ° ° ° ° ®���00�®��O OOOO�DO®®�®O ° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH ,00000000000 >°000°o°o °o°o°o°o GAS BAFFLE :.; o n.� , FOR LEVELNESS N i°o°oo OI—�®���E2��� �0����0���0 °o°o°o°o , E ^Q �� UTILITY POLE 88 35' 88 18 310 CMR 15.000 (TITLE 5.) )°D°o°o°o °°°o°°°o gr 9 .+: 4' LIQ. LEVEL (ACME OR EQUAL) o FIRE HYDRANT i, y... .. ,. . .:•,. .....•..•.. . 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO rn •o°ono°o°o°ono°o°ono°o°o°o°o°ono°o°o°o°o°o°o°o NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING o0000000 0 00 00°0000o°000r,o9ogo°ogo°o°000. 3�4"-1-1�2" DOUBLE WASHED STONE 4' MIN. H-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. BE USED FOR LOT LINE STAKING OR ANY OTHER (4) UNITS REQUIRED PURPOSE. ROUt� 6 a ALL AROUND PRECAST STRUCTURES 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 42.00' X 12.83' 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. Locus COMPACTION. (15.221 [2]) 10*THE INSTALLER SHALL VERIFY THE 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND LOCATIONS OF ALL UTILITIES AND ALL PERMISSION OBTAINED FROM BOARD OF HEALTH. BUILDING SEWER OUTLETS AND LOCUS M p p ELEVATIONS PRIOR TO INSTALLING ANY 81.0' BOTTOM TH-1 DIGSAFE10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING y /`1r" PORTION OF SEPTIC SYSTEM ( 2'5% SLOPE MIN.) ( 1 % SLOPE) ( 1 % SLOPE) NO GROUNDWATER FOUND LOCATION (1 F ALL UNDERGROUND AND VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES SCALE 1"=2000't FOUNDATION — 10' SEPTIC TANK 21 ' D' BOX 18' LEACHING PRIOR TO COMMENCEMENT OF WORK.FACILITY ASSESSORS MAP 298 PARCEL 75 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED BENEATH AND 5' AROUND THE PROPOSED LEACHING FACILITY. N *11 '5 885 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND ZONING SUMMARY 9 REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 86vvic � ZONING DISTRICT: RF-1 DISTRICT �' 87 MIN. LOT SIZE 43,560 S.F. ��� MIN. LOT FRONTAGE 20' MIN. LOT WIDTH 125' 00 90 89 MIN. FRONT SETBACK 30' MIN. SIDE SETBACK 15' SYSTEM DESIGN. G G — G o MIN. REAR SETBACK 15' GARBAGE DISPOSER IS NOT ALLOWED MAX. BUILDING HEIGHT 30' EXISTING 3 BEDROOM DWELLING SITE IS LOCATED WITHIN THE AQUIFER CONCRETE / PROTECTION OVERLAY DISTRICT PROPOSED 5 BEDROOM DWELLING DESIGN FLOW: 5 BEDROOMS @ 110 GPD = 550 GPD DRIVE 0�1 USE A 550 GPD DESIGN FLOW / DECK SEPTIC TANK: 550 GPD (2) = 1100 USE A 1500 GAL. SEPTIC TANK �+ EXISTING f--� ------- DWELLING LEACHING: TOF = 92.3 SIDES: 2 (42 + 12.83) 2 (.74) = 162 GPD j BOTTOM 42 x 12.83 (.74) = 398 GPD U LUMBING BE TO BE TOTAL: 756 S.F. 560 GPD 0 0 i\" �--- �r��� �����_ _ RE—ROUTED 4 J USE (4) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) N o �u WITH 4' STONE ALL AROUND . _..j PROPOSED ADDITION TH APPROVED DATE BOARD OF HEALTH MA A�TIO 1 bo o EL IR C LI- E o 0 THIS AR A N `' 91 � 12. ' — N LOT H2 37,797 S.F. _ , BENCHMARK: CATCH BASIN ` 007- R ERVE TEST HOLE LOGS =95.8' NAVD88 — FERRARI SE 13871 [89 � o ENGINEER: CRAIG J. # 88 0 z WITNESS: DONALD DESMARAIS 5' REMOV L OF UNSUITABLE SOIL R UIRED DATE: 5-19-2017 AROUND P t ETER OF LEACHING F CILITY, DOWPERC. RATE _ < 2 MIN/INCH ) � WITH CLEAN TO UCLEANMEDL E SOIL LAYER. E LACE SAND, TO MEET 15343 / SPECIFICATIONS OF 310 CMR 15.2 5(3) P CLASS SOILS # I / PR E 60' OF 40 MIL LINER AT 5' 0 SAS IN AREA SHOWN. TOP AT ELEV. 88.8', BOTTOM AT EL. 84.8'f ELEV. � ELEV. ELEV. � ELEV. TITLE 5 SITE PLAN 0> 4 92' 0.1 4 92' 0" `� 92' 0" 4 92' 24'> L FILL 24" FILL , OF FILL 12" FILL oo 14» A A 77 `0A'H LANE LS LS A 10YR 3/2 10YR 3/2 A LS 36 40 ' LSN%0'4 3" T A B A R L E t 0 A 10YR 3/2 B B 10YR 3/2 9 16" LS LS 14" 9s PREPARED FOR B 1OYR 5/8 1OYR 5/8 B LS 42" 88.5 48" 88' LS 96 SARAH %..,p %,j 1 "'K 36" 10YR 5/8 89, C 1 C 1 32» 10YR 5/8 89.3' � � > >. FLs FLs � ' 011 DATE: J U N E 29, 2017 C 72" 1OYR 7/2 86' 84" 1OYR 7/2 85' C 0 _ Scale: 1"= 20' PERC PERC C 2 C 2 --- MS MS 99 2r•1_� , 0 10 20 30 40 50 FEET M S M S ��N OF Mgss� tN OF hfgSs�c > 10YR 7/4 10YR 7/4 10YR 7/4 10YR 7/4 --- a` E3ANiEL L o�' yG 132 81 ' 132 g 1 132 g 1 132 g 1 �c,�of Mqs DANiEL A. off 508-362— 880 � sy � � A. � � OJALA �, ti�� Ass �� iDANIEL cyG OJALA `v' CIViL � qcy fax 508-362-9880 100 A. ' q No,40980 No.46502 � DO�I�EA `sm downcape.com NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED /� 1�' No0409t30 �cFEss.. %off °�FFG�sTeR����w o CIVIL //�� . r . • 9S NAL�� No 46502 � flown cNpe eft 14ee//ng, Inc civil engineers �?SuR AL E land surveyors , 1 939 Main Street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 D CE # 17-0 9 6 17-096